Primary cutaneous anaplastic large cell lymphoma masquerading as large pyogenic granuloma.

Primary cutaneous anaplastic large cell lymphoma (pcALCL) forms 9% of the cutaneous T-cell lymphomas. It usually presents as solitary reddish brown ulcerating nodule or indurated plaque. Sometimes, it mimics other dermatological diseases such as eczema, pyoderma gangrenosum, pyogenic granuloma, morphea, and squamous cell carcinoma. Our case presented with large pyogenic granuloma like lesion with regional lymphadenopathy. Since pcALCL is rare, one can misdiagnose such cases and therefore high index of suspicion is necessary.

Unusual presentation of mucocutaneous leishmaniasis in HIV-infected patient.

Leishmaniasis is caused by protozoan parasite of genus leishmania. Visceral leishmaniasis, diffuse cutaneous leishmaniasis, and atypical forms of cutaneous leishmaniasis are common in HIV-infected patients. Our patient presented with an obstructive mass in nasal cavity and was diagnosed as a case of mucocutaneous leishmaniasis. Spontaneous healing of lesions in HIV-infected patients is rare rather they are unresponsive to treatment and have frequent relapses, especially in patients with low CD4 count. However, in our patient, the lesion improved significantly after 2 months of highly active antiretroviral therapy and co-trimoxazole prophylaxis.

Facial lupus vulgaris of bilateral periorbital skin and conjunctiva: a case report and brief review.

A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.

A rare case of diffuse cutaneous leishmaniasis in an immunocompetent patient from sub-Himalayan India.

Diffuse cutaneous leishmaniasis (DCL) is a rare variant of cutaneous leishmaniasis (CL) characterised by multiple (≥10), widespread, slowly progressive, cosmetically disfiguring, non-ulcerating nodules without visceral involvement. The disease is resistant to chemotherapy and characterized by relapses. We present a rare case of a patient with DCL who had extensive lesions (282) and who was HIV negative from a new focus of leishmaniasis in sub-Himalayan India. A favourable response with a regression of the lesions was observed after a month of treatment with intravenous and intralesional sodium stibogluconate with oral pentoxiphyline. Familiarity with such exceptional cases in immunocompetent individuals may facilitate diagnosis and a promising treatment outcome.

Clinico-epidemiological trends of leprosy in Himachal Pradesh: a five year study.

This retrospective study was done to determine the epidemiological and clinical profile of leprosy patients in a tertiary care centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. In this study, we included patients registered from January 2004 to December 2008 with the urban leprosy clinic of our tertiary care centre. Data regarding demographic details, clinical features, treatment and complications was extracted from the records of the leprosy clinic. 163 patients attended the clinic during this period with male to female ratio of 3:1. Majority of patients (47.8%) were in the middle age group (20-40 years) and 13.49% patients were < 20 years of age. In the clinical disease spectrum, 53.98% patients were in the borderline spectrum followed by lepromatous leprosy (33.12%) and polar tuberculoid leprosy (5.52%). Pure neuritic and indeterminate leprosy accounted for 3.06% each. Histoid lesions were present in 7.4% of lepromatous leprosy patients. 9.2% patients had definite history of contact in the family or neighborhood. 28.22% patients were immigrants either from Nepal or adjoining states of Himachal Pradesh. Epidemiological studies and contact tracing can decrease the disease burden and morbidity associated with the disease. Multidrug therapy (MDT) helps preventing and reducing the disease progression, severity and disabilities.

Severe form of type 2 reaction in patients of Hansen's disease after withdrawal of thalidomide: case reports.

Thalidomide, a racemic glutamic acid analogue, was first developed in 1954 and subsequently marketed in Europe, Australia and Canada as a sedative and anti-emetic. It was approved by the Food and Drug Administration (FDA) in the USA in 1998 for the treatment of the cutaneous manifestations of moderate to severe erythema nodosum leprosum (ENL) and suppression of the cutaneous manifestations of ENL recurrences. It is a good choice for management in patients who are dependent on corticosteroids. Common side effects of thalidomide are teratogenicity, peripheral neuropathy, sedation and constipation. We report 4 cases of Hansen's disease with recurrent ENL who were adequately managed on thalidomide. On sudden withdrawal of thalidomide, they relapsed with severe type 2 reaction including necrotic ENL.